This past week, Google had its annual developers conference, Google I/O. One of the more provocative talks, called “The End of Search as We Know It,” was by Amit Singhal, who is in charge of search for Google.

The vision, as described by Amit, is that instead of typing words into a box on a website or mobile app, we will have conversations with Google, enabling a much more personalized, refined experience. The holy grail, of course, is that Google analytics become both predictive and prescriptive, serving you content that is just right for you and anticipates your needs.

It seems there is a race on now to achieve this vision. One could argue that Amazon, Apple, Facebook, Pandora and others are all in the same mode. Best I can tell, the promise these companies are floating to advertisers is that their ads will be served up to that focused slice of the population that will find their product relevant in the moment.

If you apply this thinking to healthcare, several controversies/topics come to the fore.

Is Google competing with IBM’s Watson? Undoubtedly yes. On the other hand, I’m guessing Google is disenchanted with the consumer health space after the demise of its personal health record (PHR). And IBM seems to be focused on clinician decision support. So early in the game, with respect to healthcare anyway, maybe there is not much competition. The path for clinician decision support is clear and the market obvious, whereas the path and market for consumer health decision support are blurry.

To achieve their vision of having a conversation with you at the level of search, Google has to know lots and lots about you. Some people are spooked by what they track now. Will there be a way for them to track all of the other necessary data points without running afoul of the privacy lobby (see the exchange between Wally and Catbert below)?

Can we achieve the same vision for consumer health information (i.e., make it highly personalized, motivational, caring, and eerily anticipatory)?

At the Center for Connected Health, we are banking on it. A big part of our research agenda for the next several years will be in this area. Current work in type 2 diabetes and cancer pain control represent a start in this area.

Perhaps the most penetrating question is whether there is an economic imperative for personalized prevention that is as compelling as the one for personalized search. We know the economics of advertising and the ultimate goal of targeting every ad to someone who is a qualified, interested customer – someone who really views the product as a solution to their problem.

I have been thinking about the counterpart in health….it is not as clear to me. Stated another way, why have we not managed to devote the kind of resources Google is devoting to personalized search to personalized prevention? For instance, if I can use your genetic analysis to predict your risk for type 2 diabetes and create a uniquely motivating self management program for you, who will find that economically appealing? You? The government? Your employer? Your health plan? Your doctor? Its not so clear.

Of course we should all want to be healthier, but we all know how that goes. Short-term discipline for long-term reward? It’s a tough one. We are not as eager consumers of health information as we are information on clothes, shoes, concerts, etc.

Who else should be interested? Payers? Hard to imagine Aetna, United or Wellpoint competing with Google in this area. Even though they pay for care, they are agents of employers. I’m guessing HR executives will be more sensitive to the privacy issues than Google is.

It is a quandary. The pay off of personalized prevention will be breathtaking – you’ll manage your own prevention and your own chronic illnesses largely without the help of a healthcare provider. This will result in improved health as well as decreased costs. Who should step up to the plate to build the war chest that will attract the talent from the ‘recommendation engine’ and/or financial industry?

It is a quandary. Thanks for your thought-provoking post, Joseph. I think it’s just human nature. Ever wonder why it is so difficult to get people to quit smoking or lose weight with scarcely 5% succeeding? I think because we handle health as an acute problem — deal with it when it comes up: relief from flu (yet fewer take flu vaccine) or toothache relief (but rare do we floss).

But when something serious happens, people clamor for 2nd and 3rd opinions, alternative therapies, experimental trials. Then, decision support for people is particularly vital. People are understandably confused and their clinicians (who are not caring for them continuously) are slow to adopt new methods. Which therapy will work for a given individual at a particular time? Well, we can do that well for some drugs today but few physicians do so.

Unfortunately the genomics field oversold the predictive side; the environmental component is a bigger piece of the puzzle. So there is nothing “average” about any of this. I think we’ll see patterns at a population level, though.

Privacy concerns take a backseat when one is fighting a grave condition. I think your instincts are correct. People need a way to help them make decisions. Google (and others) can do the data science that unites many key points to provide more personalized guidance than a simple search for data “by the averages.” Maybe it is at that point that people provide more detailed data that can be used to guide them. Then, in time, people will see better results. To borrow from Garrison Keillor, because we’re “all above average!”